N-Acetylcysteine for Refractory OCD

This derivative of cysteine, with glutamate-modulating properties, provides modest benefits to patients who are symptomatic after an initial antidepressant trial.

Although selective serotonin reuptake inhibitors (SSRIs) are effective for obsessive-compulsive disorder (OCD), many patients fail to respond adequately, and there are few evidence-based second-step options (largely, augmentation with antipsychotics). Investigators in Iran randomized 48 patients with treatment-refractory OCD (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] scores, ≥16 after 12 weeks of SSRI or clomipramine) to 12 weeks of continued antidepressant plus the glutamatergic modulator N-acetylcysteine (NAC; 600–2400 mg/day) or placebo.

Response (≥35% reduction in Y-BOCS score) was significantly greater with NAC (53%) than placebo (15%). NAC was well tolerated, with modest adverse effects of diarrhea and nausea/vomiting in one third…

Reviewing Author

Peter Roy-Byrne, MD

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Peter Roy-Byrne, MD

Disclosures

Editorial BoardsUpToDate

N-Acetylcysteine for Refractory OCD

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Reviewing Author